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Published on: September 25, 2019
Diffusion-Weighted Lesions After Intracerebral Hemorrhage: Associated MRI Findings
Kim Wiegertjes1, Sabine Voigt2, Wilmar M T Jolink3
1Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
Abstract:
The current study aimed to investigate whether diffusion-weighted imaging-positive (DWI+) lesions after acute intracerebral hemorrhage (ICH) are associated with underlying small vessel disease (SVD) or linked to the acute ICH. We included patients ≥18 years with spontaneous ICH confirmed on neuroimaging and performed 3T MRIs after a median of 11 days (interquartile range [IQR] 6-43). DWI+ lesions were assessed in relation to the hematoma (perihematomal vs. distant and ipsilateral vs. contralateral). Differences in clinical characteristics, ICH characteristics, and MRI markers of SVD between participants with or without DWI+ lesions were investigated using non-parametric tests. We observed 54 DWI+ lesions in 30 (22%) of the 138 patients (median age [IQR] 65 [55-73] years; 71% men, 59 lobar ICH) with available DWI images. We found DWI+ lesions ipsilateral (54%) and contralateral (46%) to the ICH, and 5 (9%) DWI+ lesions were located in the immediate perihematomal region. DWI+ lesion presence was associated with probable CAA diagnosis (38 vs. 15%, p = 0.01) and larger ICH volumes (37 [8-47] vs. 12 [6-24] ml, p = 0.01), but not with imaging features of SVD. Our findings suggest that DWI+ lesions after ICH are a feature of both the underlying SVD and ICH-related mechanisms.
Insights
Diffusion-weighted imaging-positive (DWI+) lesions following acute intracerebral hemorrhage (ICH) are linked to cerebral amyloid angiopathy (CAA) and larger hemorrhage volumes, suggesting dual ICH-related and small vessel disease (SVD) mechanisms.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Acute intracerebral hemorrhage (ICH) is a severe neurological condition.
- Diffusion-weighted imaging-positive (DWI+) lesions are observed after ICH, but their origin remains unclear.
- Understanding DWI+ lesion etiology is crucial for managing ICH and associated small vessel disease (SVD).
Purpose of the Study:
- To investigate the association between DWI+ lesions after acute ICH and underlying SVD.
- To determine if DWI+ lesions are linked to the acute ICH event itself.
- To explore the relationship between DWI+ lesions and specific SVD markers and ICH characteristics.
Main Methods:
- Retrospective analysis of 138 patients with spontaneous ICH undergoing 3T MRI.
- Assessment of DWI+ lesions relative to the hematoma location (perihematomal, ipsilateral, contralateral).
- Comparison of clinical, ICH, and SVD imaging characteristics between patients with and without DWI+ lesions using non-parametric tests.
Main Results:
- DWI+ lesions were present in 22% of patients, often located distant from the ICH.
- DWI+ lesion presence was significantly associated with probable cerebral amyloid angiopathy (CAA) diagnosis and larger ICH volumes.
- No significant association was found between DWI+ lesions and other common imaging features of SVD.
Conclusions:
- DWI+ lesions after ICH are associated with underlying SVD, particularly CAA.
- These lesions appear to be influenced by both ICH-related mechanisms and pre-existing SVD.
- Further research is needed to elucidate the precise pathophysiological pathways linking DWI+ lesions, ICH, and SVD.
